We need to talk about PND

There’s something that affects nearly a third of Kiwi mums, yet no one seems keen to talk about it. Victoria Wells finds there’s a big black elephant in the room that needs confronting.

What do you think of when I say: Postnatal depression? Would it be a mum lying in a darkened room, having dreadful thoughts about harming herself or her baby?

What if I told you it’s also the mum in your coffee group who seems completely together, but is secretly dreading going home to cope with the baby on her own and can’t sleep at night? Or the woman with a six-month-old who feels like she’s struggling to be a ‘perfect’ mum and cries nearly every day?

In the same way that John Kirwan came into our living rooms and helped people (many of them blokes) open up about their depression, mums also need to come clean about how they’re feeling. Because it’s becoming increasingly clear that many of us are not okay. And while the mum in the dark room and the mum at coffee group may seem poles apart, they are both examples of postnatal experiences that as many as a third of Kiwi mums are going through.

Officially, postnatal depression is believed to affect at least 15 per cent of mothers in New Zealand, but when you take into account the mums who experience what is termed ‘postnatal distress’, that figure is thought to sit closer to 30 per cent.

Look around your coffee group. If there are six of you then, statistically, one of you is going to experience postnatal depression, and there’s another who is going to have postnatal distress. Who is it? Is it you? How do you know if you don’t talk about it?

What is postnatal depression?

There’s a phase known as ‘the baby blues’, which refers to the time immediately after having a baby when your body adjusts to the enormity of what it’s just been through, and your hormones and emotions fluctuate. It’s completely normal and can make you feel weepy, moody, anxious and unable to sleep and can last anywhere from three or four days, to up to two weeks.

But then it should stop. Any sadness, anxiety or not feeling able to cope after that time can be signals that something is not right, and shouldn’t be ignored. And, crucially, it doesn’t necessarily mean depression.

“There are a lot of us using the word ‘distress’ now, because depression is just one aspect of what it is that women experience, and it’s everything,” says psychotherapist Susan Goldstiver, of The Postnatal Distress Centre. “It’s everything in the perinatal phase: antenatal, postnatal, birth trauma, anxiety, depression, psychosis, OCD, panic attacks; it’s adjustments to parenting, and it’s men and women.”

Through her Auckland-based practice offering counselling and psychotherapeutic treatment, Susan works with women who are struggling in some way. “Often they know something is wrong but they don’t want it to be wrong and other times they’re relieved to hear that it sounds like they’re really not well.”

Postnatal distress or depression is recognised as occurring any time in the first 12 months following the birth and can come after each baby, or with just one and not the others – there’s no pattern. Susan says the important thing is recognising the symptoms and seeking help.

“A lot of women are left feeling like they don’t have depression because they get up in the morning and they love their baby, but they also know that something’s not right – but they think ‘I’m not depressed, so that can’t be me’.”

She says it can be harder for women experiencing depression to seek help in the first place because the nature of the illness makes it harder for them to pick up the phone or get out of the house to get help. In more severe cases she will refer people to their GP for medication or to a psychiatrist.

At the more extreme end of the spectrum mothers may be referred to maternal mental health services. Dr Tanya Wright is a psychiatrist at the Mother and Baby Unit, a family-oriented space within Auckland’s Starship Hospital.

“The postnatal period is a higher risk time because of all the biological and psychological issues,” says Tanya. “Everything can be brought to bear around that: your relationship, your sense of who you are, your change out of a career and into something else, sleep deprivation and all the biological changes that pregnancy and birth bring.”

She says while she and her colleagues are working with the mothers who have a significant episode of postnatal depression, it’s important to acknowledge there are many more mums across the country who will experience it at lower levels and won’t necessarily require medication. “Some early depression will respond to psychological intervention, and increasing support and helping mums get some sleep, but sometimes more is needed.”

That’s where the Mother and Baby Unit comes in. Tanya says most mothers who come into hospital do so because their illness is such that they need more than community options can provide. Sometimes this is because they pose a risk to themselves, or to their baby, but this is not always the case. Patients and their babies stay for an average of three weeks and are cared for by a team of psychiatrists, psychologists, occupational therapists, nurses, social workers, and cultural team support members.

“They don’t all come here on medication, but at this point, medication is usually part of their treatment,” explains Tanya. “But we also help people by talking about thoughts, feelings and relationships, helping them to make sense and work through the many issues that can arise for women as they become parents and roles in life change. We think of relationships as being of huge importance, particularly with partners, family and whanau. Helping fathers understand how they can support their partners is very important.” She also notes that when mothers develop postnatal depression there are studies that show about 30 per cent of fathers go on to develop it too.

How to get help

“There will be a ton of women whom no one ever sees, because they wear the mask and manage their days half an hour at a time just to get through, and nobody knows,” says Susan. “No help, no support. It’s so sad.”

The good news is, there is help available for everything from milder forms of postnatal distress, through to severe postnatal depression – it’s just about taking the steps to find it. If you or anyone you know are experiencing any of the symptoms in the box on the previous page, then seek help, and don’t give up.

“If the first person isn’t getting what she’s trying to say then keep on pursuing it,” says Susan. “If she can, ask her partner to help her, ask her best friend, her mother – just get some support. And find some help, either through your GP or private services. For the women where there aren’t any therapists, services or counsellors in their town, you can have Skype sessions or telephone support.

“It is treatable and the sooner you get onto it the sooner you are healed and the less impact it will have on the family and on the relationship; [and] the sooner you’re able to better enjoy mothering.”

Even joining a support group, where you can talk to others going through similar things can be helpful. Sarah, a 35-year-old mother of two from Wellington, is part of a closed Facebook group called PND Wellington, which has several hundred members and holds fortnightly get-togethers.

“Often things aren’t perfect and you don’t have to give this shiny [view],” says Sarah. “It was relieving to hear that other women had anxieties too.”

“I was [usually] a bubbly, positive, friendly person, and I didn’t feel like that,” says Megan. “If you don’t feel like your normal self – even though you’re tired or hormonal or whatever – just speak to someone, a friend or relative or your GP, just so you can verbalise it. The worst thing you can do is keep it inside and not acknowledge it – saying it out loud to someone might get you taking those first steps.”

Where to get help

Talk to your GP, midwife or Plunket nurse so they can help you to get help, show this article to a friend or family member to start the conversation, or contact one of the services listed here: